Eating Disorders as a Result of Military Sexual Trauma in Veterans

Veterans who screen positive for MST are at differentially greater risk for PTSD, depression, substance misuse, and homelessness.

Veterans who experienced military sexual trauma (MST) are at higher risk for post-deployment eating disorders (EDs), according to a new study1 conducted by Rebecca Blais, PhD, assistant professor of psychology, Utah State University in Logan, and colleagues.

According to the United States Department of Veterans Affairs (VA) MST affects 25% of female and 1% of male veterans and includes “any sexual activity where a service member is involved against his or her will.”2

It is known that veterans who screen positive for MST are “at differentially greater risk for adverse sequelae such as PTSD, depression, substance misuse and homelessness, relative to veterans who screen negative for MST,” the researchers write. However, few studies have examined whether veterans with a history of MST have a greater likelihood of being diagnosed with EDs, and whether this relationship varies by sex.

To investigate this question, the researchers conducted a retrospective cohort study of US Afghanistan/Iraq veterans who utilized the Veterans Health Administration (VHA) services over a 10-year period. Using VHA administrative data the researchers assessed the presence of ED diagnoses in veterans' medical records within 1 and 5 years of initiating VHA care, and whether a positive screen for MST was associated with EDs.

The researchers analyzed 2 cohorts with fixed 1- and 5-year follow-up. The 1-year cohort consisted of 595,525 veterans who had at least 1 year of clinical follow-up data. Of these, 265,806 had available 5-year data. Administrative follow-up began on the date of the veteran's first encounter with the VHA following the last deployment.

Of the total number of medical records examined (n=595,525), 3% (n=18,488) of veterans screened positive for MST. In the 1-year cohort, 0.01% (n=513, 74% female) had a diagnosis of ED, and in the 5-year cohort, 0.2% (n=504, 71% female) had a diagnosis of ED.

In both cohorts, EDs were higher in female veterans, veterans with never-married status, younger age, non-black race/ethnicity, active duty service, service in the Navy/Coast Guard and Air Force, and a positive screen for MST. Veterans with significantly higher rates of posttraumatic stress disorder (PTSD), depressive disorders, and alcohol- and substance-related disorders were also more likely to be diagnosed with EDs.

When researchers used regression models to adjust for demographic variables, military service, and psychiatric comorbidities, they found that individuals with a positive screen for MST at 1 year and 5 years had approximately double the adjusted odds for ED diagnoses (adjusted odds ratio (AOR) 2.03, 95% CI1.64-2.50 and AOR 1.90, 95% CI 1.53-2.36, respectively). The association was differentially stronger in male than in female veterans in the 1-year cohort (AOR 2.13; 95% CI 1.01-4.50).

The investigators observed that MST and EDs in veterans are “understudied public health concerns” that “share many of the same psychiatric distress correlates including PTSD, depression, substance misuse, and homelessness.”

They acknowledged that the sample was restricted only to users of VA care, thereby limiting how much the findings can be generalized. Moreover, pre- and post-military experiences not included in the study might increase or explain the likelihood of EDs in this population.

Nevertheless, they conclude that “gaining a more comprehensive understanding of the association between two understudied health concerns, MST and EDs, could inform the development of targeted ED screening strategies, thereby improving early detection and allowing for the timely provision of appropriate treatment, such as trauma-informed care.”